CBTp for people with treatment refractory schizophrenia on clozapine: a systematic review and meta-analysis

Abstract

Background

Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia.

Aims

A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine.

Methods

We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses.

Results

Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was not significantly altered by CBTp at either therapy endpoint or six to twelve months follow-up. Secondary outcomes showed that CBT improved positive symptoms at both therapy endpoint (SMD −0.33, 95%CI −0.50 to −0.16, p = 0.002, I² = 0%) and six to twelve months follow-up (SMD −0.20, 95%CI −0.38 to −0.02, p = 0.03, I² = 0%) though did not alter negative psychotic symptoms at either timepoint.

Conclusions

CBTp may lead to small benefits for positive symptoms refractory to clozapine. Given the low risks associated with CBTp, and the limited alternative options for clozapine refractory schizophrenia, this approach should be considered in this population.

Keywords:

• Treatment refractory schizophrenia
• clozapine
• CBTp
• systematic review
• meta-analysis

Acknowledgements

We would like to thank Dr Valmaggia for providing data desegregated for participants on clozapine.

Author contributions

DS conceived of the project, search and analysis plan with input from SK. AT devised the search strategy with input from SL, DS and SK. AT and SL conducted the search and data extraction. AT conducted the data analysis with support from DS and SK. AT interpreted the data with input from VDM, FD, DS and SK. AT wrote the first draft of the manuscript with input from all authors. All authors reviewed the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).